Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer, and the relation between No.12b lymph node metastasis and clinicopathologic factors. Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively, both of which were all plus No.12b lymph node dissections. The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed. Results No death attributed to operation or severe operative complications were found. There were 12 cases (20.00%) with No.12b lymph node metastasis. The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types, N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25% (10/32), 30.30% (10/33) and 29.73% (11/37), which were significantly higher than those in Borrmann Ⅰ-Ⅱ types 〔7.14% （2/28）〕, N0-1 〔7.41% （2/27）〕 and T1-2 〔4.35% （1/23）〕 respectively (Plt;0.05). There was no relationship between tumor size and No.12b lymph node metastasis. Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer. Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.
ObjectiveTo investigate the relationship between topical reactive lymphoid hyperplasia and postoperative recurrence and survival of gastric cancer patients. MethodsThe clinical and pathological data of gastric cancer patients who underwent D2 radical gastrectomy from January 2007 to July 2009 were retrospectively analyzed. Based on the number of reactive lymph nodes, cases were divided in to topical reactive lymphoid hyperplasia group (RLH, n=18) and non-RLH group (n=43) by using a median method. The postoperative disease-free survival (DFS) and overall survival (OS) rates of patients in different groups were compared using Kaplan-Meier method and log-rank test, respectively. ResultsThere were no significant difference between the two groups in age, gender, pathological stage, surgical approach, extent of surgery or methods of postoperative chemotherapy (P > 0.05). The median disease-free survival time was 50 months in RLH group, and the median disease-free survival time was 39 months in non-RLH group. DFS of patients in RLH group was significant higher than non-RLH group (66.7% vs. 34.9%, P=0.048). The median survival time was 53.6 months and 52.3 months, respectively, in RLH group and non-RLH group. No difference was found in OS between the two groups (72.2% vs. 60.5%, P=0.338). ConclusionTopical reactive lymphoid hyperplasia reactive the immunity of gastric cancer patients and contact postoperative DFS rate.
ObjectiveTo explore the value of fluorescence tracer technique in sentinel lymph node (SLN) orientation of cN0 papillary thyroid cancer. MethodsThe total clinical data of 40 cT1-3N0M0 thyroid cancer patients admitted from January 2015 to January 2016 in our hospital were collected, and the SLN with indocyanine green (ICG) as fluorescent trace agent were observed and detected, and the effect of ICG detecting SLN and the guide role of SLNB on the dissection of the central area of neck lymph nodes by intraoperative frozen biopsy pathology and postoperative paraffin pathology were analyzed. ResultsA total of 40 thyroid cancer patients were treated by SLNB and then conducted by the dissection of the central area of neck lymph nodes, and 37 cases detected SLN, so the detection rate was 92.5% (37/40). And a total of 98 SLNs were detected, 1-5 for each case, average of 2.65/case. Intraoperative frozen pathological detected 28 cases of patients with metastases in SLN, and 9 patients without metastasis, including 1 case with postoperative pathology detecting micrometastasis in SLN and other 8 cases without metastasis in the central area of neck lymph nodes. Three cases who were not detected the SLN showed no metastases in final postoperative paraffin pathology. The SLNB of ICG fluorescent tracer was with a sensitivity of 96.6% (28/29), false-negative rate of 3.45% (1/29). ConclusionThe fluorescent tracer technique can guide the dissection of the central of neck lymph node of cN0 thyroid cancer patients accurately with a high detection rate and advantages of high sensitivity in detecting the SLN of thyroid cancer.
Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ2=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ2=0.139, P=0.709; χ2=0.578, P=0.447; χ2=2.617, P=0.106; χ2=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.
ObjectiveTo explore the factors associated with non-sentinel lymph node (NSLN) metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes (SLN), seeking the basis for exempting some SLN-positive patients from axillary lymph node dissection. MethodsA total of 299 early breast cancer patients who were diagnosed with positive sentinel lymph node (SLN) biopsy and underwent axillary lymph node dissection at the Affiliated Hospital of Southwest Medical University from January 2019 to April 2023 were selected. Univariate analysis was performed on the clinical and pathological data of patients, and multivariate logistic regression analysis was conducted to identify factors related to axillary non-sentinel lymph node (NSLN) metastasis of patients with SLN positive in early breast cancer. GraphPad Prim 9.0 was used to draw receiver operating characteristic (ROC) curve, and the area under curve (AUC) of ROC was calculated to quantify the predictive value of risk factors. ResultsAmong the 299 breast cancer patients with 1-2 SLN positive, 101 cases (33.78%) were NSLN positive and 198 cases (66.22%) were NSLN negative. Univariate analysis showed that the number of positive SLN, clinical T staging and lymphovascular invasion were related to the metastasis of NSLN (P<0.001). Multivariate logistic regression analysis indicated that having 2 positive SLN [OR=3.601, 95%CI (2.005, 6.470), P<0.001], clinical T2 staging [OR=4.681, 95%CI (2.633, 8.323), P<0.001], and presence lymphovascular invasion [OR=3.781, 95%CI (2.124, 6.730), P<0.001] were risk factors affecting axillary NSLN metastasis. The AUCs of the three risk factors were 0.623 3, 0.702 7 and 0.682 5, respectively, and the AUCs all were greater than 0.6, suggesting that the three risk factors had good predictive ability for NSLN metastasis. ConclusionThe number of positive SLN, clinical T staging, and lymphovascular invasion are related factors affecting NSLN metastasis in early breast cancer patients with positive SLN, and these factors have guiding significance for whether to exempt axillary lymph node dissection.
ObjectiveTo investigate the vaules of multi-slice spiral CT (MSCT) in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer. MethodsFifty-nine patients with gastric cancer performed preoperative MSCT plain scan and triple enhanced scans from February 2019 to March 2021 in the First People’s Hospital of Wuhu City were collected. The results of postoperative pathology were taken as the gold standard, the short diameter, long diameter, short to long diameter ratio, CT values of triple enhanced scans and lymphatic hilar blur were compared between the metastatic lymph nodes and the non-metastatic lymph nodes. ResultsThe preoperative MSCT showed that there were 50 cases of metastatic lymph nodes and 9 cases of non-metastatic lymph nodes in 59 patients with gastric cancer. A total of 1 467 lymph nodes were harvested, including 562 metastatic lymph nodes and 905 non-metastatic lymph nodes. The short diameter, long diameter, short to long diameter ratio, and the CT values of plain scan, arterial phase, portal vein phase, and delayed phase of metastatic lymph nodes were higher than those of non-metastatic lymph nodes (P<0.05), and the incidence of lymphatic hilar blur was also higher than that of non-metastatic lymph nodes (P<0.05). Referring to the results of postoperative pathological examination, the accuracies of MSCT in judging of N0, N1, N2, N3a, and N3b stages were 88.9% (8/9), 83.3% (5/6), 85.7% (12/14), 92.3% (12/13), 88.2% (15/17), respectively, and the total accuracy was 88.1% (52/59), the specificity was 96.6% (57/59), and the sensitivity was 91.2% (52/57). ConclusionAccording to this study results, preoperative MSCT has higher specificity, sensitivity, and accuracy in diagnosing metastatic lymph nodes and judging N stage of resectable gastric cancer.
ObjectiveTo assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. MethodsThe medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. ResultsThe upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. ConclusionThe effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.
ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
ObjectiveTo investigate the role of intraoperative frozen section pathology in central lymph node metastasis of papillary thyroid microcarcinoma (PTMC), and to analyze the risk factors of central lymph node metastasis.MethodsClinical data of 481 patients diagnosed with PTMC from January 2015 to June 2019 in our hospital were included. The consistency of frozen pathological results of intraoperative prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes with postoperative paraffin pathological results, as well as the relationship between the numbers of intraoperative lymph nodes sent for examination and postoperative pathological results were analyzed. Then the Kappa value were calculated respectively. Furthermore, univariate and multivariate analysis were used to analyze the factors affecting central lymph node metastasis.ResultsCentral lymph node metastasis was found in 207 patients with PTMC (43.0%). Of the 207 patients, 192 patients were examined by frozen section, with 139 patients had positive results. The Kappa value of prelaryngeal lymph nodes, paratracheal lymph nodes, pretracheal lymph nodes, and central lymph nodes were 0.300, 0.643, 0.560, and 0.755, respectively (P<0.001). Simultaneous intraoperative examination of three anatomic lymph nodes in the central region has a high accuracy in evaluating whether there was lymph node metastasis. The consistency test between intraoperative frozen and postoperative paraffin pathological results showed that when the number of lymph nodes was less than 5, the Kappa value was 0.690 (P<0.001), and when more than or equal to 5, the Kappa value was 0.816 (P<0.001). The results of logistic regression showed that, maximum value of tumor diameter, tumor number, and thyroid capsule involvement were risk factors for central region lymph node metastasis in PTMC (P<0.05).ConclusionsCentral region lymph node metastasis in PTMC was common. Prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes should be selected for frozen pathological examination during the operation, which could effectively indicate whether the central lymph nodes were involved. And combined with the risk factors of lymph node metastasis, such as maximum value of tumor diameter, number of tumors, and thyroid capsule involvement, a more accurate individualized operation plan can be designed for patients.